red cell distribution width index versus red cell distribution width as discriminating guide for iron deficiency anaemia and beta thalassemia trait .

Conditions: Microcytic Hypochromic Anemia

Summary: red cell distribution width index versus red cell distribution width as discriminating guide for iron deficiency anaemia and beta thalassemia trait .

microcytic hypochromic anaemia is very common hematological abnormality in the clinical practice ( snakar et;al. 2016 ) . iron deficiency anaemia and beta thalassemia trait are the most common causes of microcytic hypochromic anaemia. as mentioned by the world health organization ( who ) estimates in 2004 , there were 273000deaths due to iron deficiency anaemia along with 19.7 million disability . approximately 1.3 % cases were recorded globally in developing countries ( kasseban et;al.2014 ) . iron deficiency anemia is the most common nutritional disorder . this type of anemia is the final phase of a process that begins with exhaustion of iron stores and continues with iron depletion from other compartments that contain it compromising normal haematopoesis ( wharton et;al. 1994 ) beta thalassemia trait is the second most common cause of microcytic hypochromic anaemia . it is genetically determined disorder in which the defect of b globin gene results in decreased production of hemoglobin a1 ( sliman et;al. 2004 ) the differentiation between iron deficiency anemia and beta thalassemia trait is important because of two main reasons . first , because hemoglobin will not improve in beta thalassemia trait if it is misdiagnosed as iron deficiency anemia and unnecessary iron being prescribed by the attending physician ( vehapoglee et;al. 2014 ) . the second grave reason is that misdiagnosed beta thalassemia trait as iron deficiency anemia may get married to a beta thalassemia trait , resulting in homozygous or thalassemia major in the offsprings ( tripathi et;al. 2015) ideally one needs a battery of tests including detailed peripheral blood picture , hba2 estimation , serum iron , tibc , serum ferritin and transferrin saturation to differentiate iron deficiency anemia from beta thalassemia trait clearly (bordbar et;al. 2015 ) . but all these investigations are either not available in all clinical setup or they are relatively time consuming and need expensive techniques ( natios et;al. 2007 ). derived indices showed that rdw is the first index of the routine blood count to become abnormal during the development of iron deficiency anemia ( mcculre et;al. 1985 ) . it quantitatively measures red blood cells size. variation computed directly from the rbcs histogram and is calculated as standard statistical value , the coefficient of variation of the volume distribution ( verma et;al. 2015 and plengsures et;al. 2015) . rdw is high in iron deficiency anemia because there is a wide variation in red cell size . in beta thalassemia trait , the red cells are all the same size , there is virtually no variation ,so rdw is low ( park et;al.2009 ) . another red cell discriminate function , rdwi had been proven to be reliable discrimination index in the differentiation between iron deficiency anemia and beta thalassemia trait ( ismail et;al.2016 ) . it can be easily calculated as ( mcv in ( fl) x rdw / rbcs in (million per microlitre ) ) quotient more than 220 suggest iron deficiency anemia , less than 220 suggest beta thalassemia trait. rdwi provide valiable help to the attending physician as all discriminating factors including rbcs count , mcv and rdw are incorporated in its formula ( jayabose et;al. 1999 ) .

Eligibility criteria:
inclusion criteria: * all patients with microcytic hypochromic anemia ( according to who , mcv less than 80 fl and hb level below the lower limit of normal value specified by age and gender . exclusion criteria: * beta thalassemia major patients . * chronic diseases or infections . * lead poisoning . * sideroblastic anaemia .